From the very beginning of this year (January 1), orthopedic practices saw a series of modifications in relevant CPT codes as a part of annual changes. As per the AMA President, the latest CPT code changes would reflect new technological and scientific advancements available and make sure that the code set can accomplish its task of reporting contemporary medical procedures effectively. However, it is required for orthopedic practices to incorporate these changes while coding for each patient encounter so as to avoid claim denials and receive reimbursements correctly. Let’s take a detailed look at those changes so that orthopedic medical coding and billing can be performed in an accurate manner.
Evaluation and Management
A new set of codes has been added to the evaluation and management (E&M) codes to cover interprofessional telephone and Internet consultations. The code set is described as “An interprofessional telephone/Internet consultation is an assessment and management service in which a patient’s treating (e.g. attending or primary) physician or other qualified health care professional requests the opinion and/or treatment advice of a physician with specific specialty expertise (the consultant) to assist the treating physician or other qualified health care professional in the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consultant” and includes a verbal as well as written report to the treating or consulting physician. However, the codes are classified according to the time taken for medical consultation and review. The new codes are:
- 99446: 5–10 minutes of medical consultation discussion and review
- 99447: 11–20 minutes of medical consultation discussion and review
- 99448: 21–30 minutes of medical consultation discussion and review
- 99449: 31 minutes or more of medical consultation discussion and review
The key points that should be kept in mind while using these codes are as follows:
- If a transfer of care has occurred before the telephone/Internet discussion, do not report these codes.
- If the telephone/Internet discussion leads to an immediate transfer of care or if the transfer of care occurs within the next 14 days or at the next appointment available, do not report these codes.
- If the duration of telephone/Internet discussion is less than 5 minutes, do not report these codes.
- While calculating the length of time, add the time taken for the review of relevant medical records, laboratory studies, medication profile, imaging studies or pathology specimens that may be required and transmitted electronically through fax or mail immediately before the telephone/Internet discussion or following the discussion.
- The written or verbal request for telephone/Internet advice by the treating/requesting physician or other qualified healthcare professional should be documented in the patient’s medical record including the reason for the request. Conclude the documentation with a verbal opinion report and a written report from the consultant to the treating/requesting physician or other qualified healthcare professional (practices would need to determine how documentation can be done to meet the requirements of written report and verbal report to the requesting provider).
The soft-tissue tumor codes may be reported for benign or malignant tumors confined to the subcutaneous tissues (not skin), fascial or subfascial tumors, or radical resection of soft-tissue connective tissue tumors. These codes are found in CPT’s musculoskeletal section. The 2014 CPT changes specify soft-tissue tumor guideline changes, which can be found throughout the musculoskeletal section. The guidelines section provides specific instructions to use the codes 11400–11446 for excision of benign lesions of cutaneous origin and 11600–11646 for radical resection of tumor(s) of cutaneous origin, such as malignant melanomas.
- 23331: removal of foreign body; deep hardware (e.g. Neer hemiarthroplasty)
- 23332: removal of foreign body; complicated (e.g. total shoulder)
- 23333: removal of foreign body, shoulder; deep (subfascial or intramuscular)
- 23334: removal of prosthesis, includes débridement and synovectomy when performed; humeral or glenoid component
- 23335: removal of prosthesis, includes débridement and synovectomy when performed; humeral and glenoid components (e.g. total shoulder)
The codes 23334 and 23335 may not be reported with the revision shoulder codes rolled out in 2013 if a prosthesis is removed and replaced in the same shoulder in the same surgical session. Refer to 23473 and 23474 for revision shoulder arthroplasty procedures.
Humerus and Elbow
The following codes and associated guideline changes were modified in the Humerus (upper arm) and Elbow section.
- 24160: removal of prosthesis, includes débridement and synovectomy when performed; humeral and ulnar components
- 24165: removal of prosthesis, includes débridement and synovectomy when performed; radial head
The guideline changes are as follows:
- References to 25200 and 24201 for removal of foreign body from the elbow
- Using 20680 for removal of deep hardware for hardware removed from the distal humerus or proximal ulna, other than humeral and ulnar prosthesis
- The code 24160 may not be reported with revision elbow codes rolled out in 2013 if a prosthesis is removed and replaced in the same elbow, same surgical setting. Refer to codes 24370 and 24371 for revision elbow arthroplasty procedures.
Sacroiliac Joint Stabilization
A new Category III code was introduced by the American Medical Association in January 2013 and implemented in July 2013. For the first time, this new code appears in the 2014 CPT manual. The code may be reported bilaterally using a modifier 50. That Category III code is:
- 0334T: Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic)
The introduction of this code demanded the addition of guideline changes to codes 27216, 27218, and 27280. Keep in mind that code 27280 describes an open sacroiliac joint arthrodesis and Category III code defines a minimally invasive (indirect visualization) approach.
New chemodenervation codes have been introduced to help pediatric orthopedic surgeons to report services for spasticity more accurately and receive more accurate reimbursement with less denials and appeals. The code 64614 was deleted due to confusing terminology and instructions and six new codes (4 primary and 2 add-on codes) were added with specificity for injections to the extremity versus the trunk muscles such as:
- 64642: Chemodenervation of one extremity; 1-4 muscle(s)
- 64643: Each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
- 64644: Chemodenervation of one extremity; 5 or more muscle(s)
- 64645: Each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure)
- 64646: Chemodenervation of trunk muscle(s); 1-5 muscle(s)
- 64647: 6 or more muscles
The code 64643 should be used in conjunction with 64642. Likewise, the code 64645 should be used in conjunction with 64644. Report either 64646 or 64647 only once in each session.
Guideline changes were introduced for electrostimulation and needle electromyography associated with chemodenervation and other destruction by neurolytic agent codes. It is required to refer to the codes 95873 and 95874 for more information as appropriate. Both of these codes have a professional and a technical component. If the procedure is performed in a facility setting, these codes require a modifier 26.
Apart from these changes, ICD-10 modifications are on its way (will be effective from October 1, 2014). Thus, orthopedic practices need to adopt the CPT changes quickly and start focusing on ICD-10 training and documentation requirements at the same time. To save time and gain the best results, it is best to partner with a professional medical billing and coding company that offers the service of trained, experienced AAPC coders.